ABSTRACT
BACKGROUND@#The complement system plays an important role in the immune response to transplantation, and the diagnostic significance of peritubular capillary (PTC) C4d deposition (C4d+) in grafts is controversial. The study aimed to fully investigate the risk factors for PTC C4d+ and analyze its significance in biopsy pathology of kidney transplantation.@*METHODS@#This retrospective study included 124 cases of kidney transplant with graft biopsy and donor-specific antibody (DSA) testing from January 2017 to December 2019 in a single center. The effects of recipient pathological indicators, eplet mismatch (MM), and DSAs on PTC C4d+ were examined using univariate and multivariate logistic regression analyses.@*RESULTS@#In total, 35/124 (28%) were PTC C4d+, including 21 with antibody-mediated rejection (AMR), eight with renal tubular injury, three with T cell-mediated rejection, one with glomerular disease, and two others. Univariate analysis revealed that DSAs (P < 0.001), glomerulitis (P < 0.001), peritubular capillaritis (P < 0.001), and human leukocyte antigen (HLA) B eplet MM (P = 0.010) were the influencing factors of PTC C4d+. According to multivariate analysis, DSAs (odds ratio [OR]: 9.608, 95% confidence interval [CI]: 2.742-33.668, P < 0.001), glomerulitis (OR: 3.581, 95%CI: 1.246-10.289, P = 0.018), and HLA B eplet MM (OR: 1.166, 95%CI: 1.005-1.353, P = 0.042) were the independent risk factors for PTC C4d+. In receiver operating characteristic curve analysis, the area under the curve was increased to 0.831 for predicting PTC C4d+ when considering glomerulitis, DSAs, and HLA B eplet MM. The proportions of HLA I DSAs and PTC C4d+ in active antibody-mediated rejection were 12/17 and 15/17, respectively; the proportions of HLA class II DSAs and PTC C4d+ in chronic AMR were 8/12 and 7/12, respectively. Furthermore, the higher the PTC C4d+ score was, the more serious the urinary occult blood and proteinuria of recipients at the time of biopsy.@*CONCLUSIONS@#PTC C4d+ was mainly observed in AMR cases. DSAs, glomerulitis, and HLA B eplet MM are the independent risk factors for PTC C4d+.
Subject(s)
Humans , Allografts , Biopsy , Complement C4b , Graft Rejection , HLA Antigens , HLA-B Antigens , Kidney Transplantation/adverse effects , Peptide Fragments , Retrospective Studies , Risk FactorsABSTRACT
Purpose To investigate the clinicopathologic features and differential diagnosis of intrapulmonary solitary fibrous tumor (SFT). Methods Features of pathology and immunohistochemical stains of 7 cases of intrapulmonary SFT were described, with review of the literatures. Results There were 4 females and 3 males in the 7 cases, aged from 24 to 65. The tumors were located in the right lobe of lung. Clinically the patients were characterized by coughing and chest pain. The tumor size ranged from 1.2 to 9.0 cm. Microscopically, it was consistent with SFT in other sites;the lesion displayed a histologic pattern with alternate hypercellular and hypocellular areas;tumor cells were admixed with collagenous stroma and arranged in bundles or swirl or hemangiopericytoma-like pattern. The cells presented short spindle, light to moderate atypia and were characterized by low mitose activity (<4/10 HPF);there was necrosis in 2 cases and epithelioid cells in 1 case;there was slite-like structure lined by benign alveolar epithelium of in all 7 cases.Immunohistochemically, the tumor cells were positive for vimentin, STAT6, CD34, BCL-2 and CD99 in areas and negative for others. Conclusion Intrapulmonary SFT is fairly rare. Its diagnosis relies mainly on imaging and histopathology and immunohistochemistry helps to distinguish it from other tumors such as pulmonary adenofibroma, malignant mesothelioma, synovial sarcoma, sarcomatoid carcinoma, the primary pulmonary meningioma. Patients have good prognosis, and radical surgery is a priority. We should pay more attention to long-term follow-up for the patients.